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摘要
Background: Clinical staging of small cell lung cancer (SCLC) is critical for its prognosis.18F-FDG PET/CT can show the shape,involvement range and metabolic status of the lesion.The purpose of this study is to explore the value of metabolic indicator,18F-FDG PET/CT in the diagnosis,clinical staging,efficacy evaluation and prognosis prediction of SCLC.Objective: To analyze the performance of metabolic parameters measured by 18F-FDG PET/CT imaging for predicting the prognosis of SCLC.Methods: Eighty-six cases of newly diagnosed SCLC who received 18F-FDG PET/CT imaging examination in the Third Affiliated Hospital of Qiqihar Medical University and the Fourth Affiliated Hospital of Harbin Medical University from 2007 to 2016 were enrolled,and divided into limited stage (LS) SCLC group (n=45) and extensive stage (ES) SCLC group (n=41) according to the examination results.The clinical data and metabolic parameters measured by 18F-FDG PET/CT imaging,including maximum standardized uptake value (SUVmax),mean standardized uptake value (SUVmean),peak standardized uptake value (SUVpeak),metabolic tumor volume (MTV) and total lesion glycolysis (TLG) with a fixed threshold of 40% SUVmax in LS SCLC group,and SUVmax,MTV,TLG of primary lesion,the biggest SUVmax of all lesions,the sum of metabolic volume (MTVsum) and TLG (TLGsum) in ES SCLC group were collected.Multivariate Cox proportional hazards analysis was performed to analyze the predictors of overall survival (OS) and progression free survival (PFS).Results: Except the rate of receiving thoracic radiation therapy was higher in the LS SCLC group (P<0.05),two groups showed no significant differences in male-to-female ratio,mean age,prevalence of smoking history,mean ECOG score,prevalence of pleural effusion,TNM stage distribution,rate of receiving systemic chemotherapy,rate of receiving whole-brain radiation as a preventative therapy,prevalence of lactate dehydrogenase (LDH) ≥245 U/L,prevalence of carcinoembryonic antigen (CEA) ≥5 μg/L,prevalence of neuron-specific enolase (NSE) ≥15.2 μg/L (P>0.05).The follow-up of 3-105 months showed that during this period,29 survived (including 24 LS SCLC patients and 5 ES SCLC patients) and 57 died (including 21 LS SCLC patients and 36 ES SCLC patients);the mean OS and PFS were 21.3,30.6 months,respectively;the 1-,2-,3-year overall survival rates were 70.9%,51.2%,29.1%,respectively;the 1-,2-,3-year progression free survival rates were 61.6%,43.0%,32.6%,respectively.Multivariate Cox proportional hazard regression analysis showed that the ECOG score of 3 to 4 points 〔HR=3.118,95%CI(1.196,8.131)〕,TNM stage Ⅲ 〔HR=7.739,95%CI(2.017,29.691)〕,and TLG 〔HR=1.056,95%CI(1.004,1.111)〕 were independent influencing factors for OS in LS SCLC patients (P<0.05);TLGsum 〔HR=3.898,95%CI(1.132,13.426)〕 was independent influencing factors for OS in ES SCLC patients (P<0.05);LDH≥245 U/L 〔HR=4.957,95%CI(1.080,3.353)〕,MTV 〔HR=1.205,95%CI(1.008,1.440)〕 were independent influencing factors of PFS in LS SCLC patients (P<0.05);ECOG score of 3-4 points〔HR=5.555,95%CI(1.697,18.183)〕,LDH≥245 U/L 〔HR=2.898,95%CI(1.326,6.335)〕,and TLGsum 〔HR=3.898,95%CI(1.355,11.211)〕 were independent influencing factors of PFS in ES SCLC patients(P<0.05).Conclusion: The volume-based metabolic parameters measured by 18F-FDG PET/CT imaging can effectively predict the prognosis of SCLC patients.TLG and MTV are the independent factors associated with OS and PFS in LS SCLC patients,and TLGsum is an independent factor associated with OS and PFS in ES SCLC patients.But there is no significant correlation between SUVmax and prognosis. ? 2019 by the Chinese General Practice.
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单位齐齐哈尔医学院; 哈尔滨医科大学
